ORDER FORM

* Please complete the following - then print this page and fax it, along with your Job Ticket to:

Specialty Optics - (805) 566-2196.   

Date of Order:

Date Required:

Company Name:

Address: 

City:    State:      Zip: 

Telephone: 

Fax: 

Contact Person: 

E-Mail Address: 

Material Required:

Shipping & Handling 

Please indicate how you would like your order shipped:  

          Option #1 - Freight prepaid - Specialty Optics will re-bill you.  

               If you choose Option #1, please check one of the following:

               UPS Ground      UPS 3-Day      UPS 2-Day     UPS Overnight

          Option #2 - Freight collect  

               If you choose Option #2, please provide us with the information

               requested below.

               Indicate ship method (Fed-X, UPS, etc.): 

               Indicate your account #: 

* PLEASE MAKE SURE YOU FAX  YOUR JOB TICKET TO:  (805) 566-2196 *